Risk factors of cognitive impairment in patients with blast-related mild traumatic brain injury
In modern local military conflicts, the prevalence of mine blast injury (MBI) is very high. In Ukraine, the frequency of MBI has significantly increased in recent years as a result of military conflict in the east of the country. Thus, it is necessary to develop a standardized approach to diagnosing mild traumatic brain injury (mTBI) effects in order to objectify the functional state of the brain and cognitive impairment (CI), to correct treatment and control in the dynamics. Predictors of CI in these patients (pts) are studied insufficiently either.
Aim. To investigate the risk factors of CI in pts with mTBI as a result of using mine explosive weapon.
Materials and methods. One hundred and fifty men aged 18 to 45 years with mTBI were examined in SI Romodanov Neurosurgery Institute of NAMS of Ukraine. The diagnosis was established in Ukrainian Military Medical Academy according to the criteria of mild traumatic brain injury determined in clinical guidelines VA/DoD Clinical Practice Guideline for Management of Concussion/mTBI (2009). The study used a single survey scheme for the pts: complaints, anamnesis morbi, neurological status, neuropsychological testing by using MoCA and HADS scales, quantitative electroencephalography (EEG), cognitive evoked potentials Р300 (CEP P300), and further phased statistical processing of the data obtained.
Results. The analysis results demonstrated the following predictors of CI as: the patients’ complaints of fatigue and headache (p=0.003), neurological signs in the form of elements of pyramidal insufficiency, increase of tendon reflexes (p=0.02), high anxiety level on the HADS scale (p=0.001), changes in KEEG indicators (p<0.05), decrease in peak amplitude P3 (p=0.003), increase in latency of CEP P300 (p=0.003).
Conclusions. The study proposed and grounded the necessity of using clinical and neurophysiological complexes to verify CI in the interim and long-term period. The study investigated the predictors of CI in pts with MBI, which is important for identification of pts with a high risk of progressive neurodegeneration as a consequence of MBI as well as for the individualization of rehabilitation approaches and treatment tactics for the pts.
Full Text:PDF (Українська)
2. Terrio H, Brenner LA, Ivins BJ, Cho JM, Helmick K, Schwab K, Scally K, Bretthauer R, Warden D. Traumatic brain injury screening: preliminary findings in a US Army Brigade Combat Team. J Head Trauma Rehabil. 2009 Jan-Feb;24(1):14-23. [CrossRef] [PubMed]
5. Wilk JE, Thomas JL, McGurk DM, Riviere LA, Castro CA, Hoge CW. Mild traumatic brain injury (concussion) during combat: lack of association of blast mechanism with persistent postconcussive symptoms. J Head Trauma Rehabil. 2010 Jan-Feb;25(1):9-14. [CrossRef] [PubMed]
6. Cernak I, Merkle AC, Koliatsos VE, Bilik JM, Luong QT, Mahota TM, Xu L, Slack N, Windle D, Ahmed FA. The pathobiology of blast injuries and blast-induced neurotrauma as identified using a new experimental model of injury in mice. Neurobiol Dis. 2011 Feb;41(2):538-51. [CrossRef] [PubMed]
8. Nelson NW, Davenport ND, Sponheim SR, Anderson CR. Blast-Related Mild Traumatic Brain Injury: Neuropsychological Evaluation and Findings. In: Kobeissy FH, editor. Brain Neurotrauma: Molecular, Neuropsychological, and Rehabilitation Aspects. Boca Raton (FL): CRC Press/Taylor & Francis; 2015. Chapter 32. [PubMed]
9. Karr JE, Areshenkoff CN, Garcia-Barrera MA. The neuropsychological outcomes of concussion: a systematic review of meta-analyses on the cognitive sequelae of mild traumatic brain injury. Neuropsychology. 2014 May;28(3):321-36. [CrossRef] [PubMed]
10. Lange RT, Pancholi S, Brickell TA, Sakura S, Bhagwat A, Merritt V, French LM. Neuropsychological outcome from blast versus non-blast: mild traumatic brain injury in U.S. military service members. J Int Neuropsychol Soc. 2012 May;18(3):595-605. [CrossRef] [PubMed]
11. McCrea M.A. Mild traumatic brain injury and postconcussion syndrome: the new evidence base for diagnosis and treatment. New York: Oxford University Press; 2008.
12. Yakhno NN, Zakharov VV. [Cognitive impairment]. In: Gusev EI, Konovalov AN, Skvortsova VI, Gekht AB, editors. [Neurology: national guidelines]. Moscow: GEOTAR; 2010. P. 532-547. Russian.
13. Polusny MA, Kehle SM, Nelson NW, Erbes CR, Arbisi PA, Thuras P. Longitudinal effects of mild traumatic brain injury and posttraumatic stress disorder comorbidity on postdeployment outcomes in national guard soldiers deployed to Iraq. Arch Gen Psychiatry. 2011 Jan;68(1):79-89. [CrossRef] [PubMed]
14. Spencer RJ, Drag LL, Walker SJ, Bieliauskas LA. Self-reported cognitive symptoms following mild traumatic brain injury are poorly associated with neuropsychological performance in OIF/OEF veterans. J Rehabil Res Dev. 2010;47(6):521-30. [CrossRef] [PubMed]
15. McKee AC, Stern RA, Nowinski CJ, Stein TD, Alvarez VE, Daneshvar DH, Lee HS, Wojtowicz SM, Hall G, Baugh CM, Riley DO, Kubilus CA, Cormier KA, Jacobs MA, Martin BR, Abraham CR, Ikezu T, Reichard RR, Wolozin BL, Budson AE, Goldstein LE, Kowall NW, Cantu RC. The spectrum of disease in chronic traumatic encephalopathy. Brain. 2013 Jan;136(Pt 1):43-64. [CrossRef] [PubMed] [PubMed Central]
16. Rapp PE, Keyser DO, Albano A, Hernandez R, Gibson DB, Zambon RA, Hairston WD, Hughes JD, Krystal A, Nichols AS. Traumatic brain injury detection using electrophysiological methods. Front Hum Neurosci. 2015 Feb 4;9:11. [CrossRef] [PubMed] [PubMed Central]
17. Solonovych O. Predictors of cognitive impairment in patients with mine blast injury. Clinical Neurophysiology. Elsevier BV; 2019 Jul;130(7):e78. [CrossRef]
18. McInnes K, Friesen CL, MacKenzie DE, Westwood DA, Boe SG. Mild Traumatic Brain Injury (mTBI) and chronic cognitive impairment: A scoping review. PLoS One. 2017 Apr 11;12(4):e0174847. [CrossRef] [PubMed] [PubMed Central]
19. Management of Concussion/mTBI Working Group. VA/DoD Clinical Practice Guideline for Management of Concussion/Mild Traumatic Brain Injury. J Rehabil Res Dev. 2009;46(6):CP1-68. [PubMed]
20. Solonovych OS. [Cognitive functions in patients at the interim and remote periods of mild traumatic brain injury (neurophysiological and neuropsychological criteria)] [dissertation]. Kyiv (Ukraine): Romodanov Neurosurgery Institute; 2017. Ukrainian.
21. Gnezditskiy VV, Korepina OS, Chatskaya AV, Klochkova OI. [Memory, Cognition and the Endogenous Evoked Potentials of the Brain: the Estimation of the Disturbance of Cognitive Functions and Capacity of Working Memory Without the Psychological Testing]. Uspekhi fiziologicheskikh nauk. 2017;48(1):3-23. Russian. Available from: https://elibrary.ru/item.asp?id=29009466
23. Stebliuk V, Gan R, Pronoza K. Particularities of physical and mental injuries for Ukrainian-Russian war victims. Journal of Education, Health and Sport. 2016 May 3;6(4):458-65.
24. Stebliuk V, Pronoza-Stebliuk K. Post-concussion Syndrome in Ukrainian Veterans: Physical and Mental Manifestations. Journal of Education, Health and Sport. 2018 Feb 26;8(2):349-54.
GOST Style Citations
Copyright (c) 2019 Lidia L. Chebotariova, Oleksandr S. Solonovych, Mykola V. Kadzhaya , Albina I. Tretiakova, Anastasiia S. Solonovych , Kateryna V. Pronoza-Stebliuk, Vsevolod V. Stebliuk
This work is licensed under a Creative Commons Attribution 4.0 International License.